Download NU 606 Exam 3: Chpt. 12, 13, 25, 26 Questions With Complete Solutions and more Exams Nursing in PDF only on Docsity!
NU 606 Exam 3: Chpt. 12, 13, 25, 26 Questions
With Complete Solutions
what are the two layers of the pericardial sac correct answer: outer fibrous pericardium anchors the heart to diaphragm visceral pericardium (epicardium) has a serous membrane what is unique about cardiac muscle (myocardial fibers) correct answer: - no nerves are present intercalated discs at the junctions between fibers (they contain desmosomes, connections to prevent muscle cells from separating during contraction, and gap junctions, which permit ions to pass from cell to cell which facilitates rapid transmission of impulses what ensures that all muscle fibers of the two atria followed by the two ventricles contract together or shortly after as it were correct answer: gap junctions and desmosomes where does a conduction impulse start correct answer: all muscle cells can start it, but it usually originates in the sinoatrial node - the pacemaker what can alter the SA node impulses correct answer: autonomic nervous system fibers and circulating hormones such as epinephrine what is the only anatomical connection between atrial and ventricle conduction in the heart correct answer: AV node
where does the cardiac electrical impulse go after the AV node correct answer: av bundle/ bundle of His, the right and left bundle branches, and the terminal purkinje network of fibers what stimulates ventricular contraction correct answer: terminal purkinje fibers? what does the P wave represent in an ECG correct answer: atrial depolarization what does the QRS wave represent in an ECG correct answer: depolarization of the ventricles - during that time it masks the effect of atrial repolarziation what does the T wave represent on an ECG correct answer: ventricular repolarization where is the cardiac control center and what does it do correct answer: medulla of the brain. responds to changes from the baroreceptors (which detect BP and are located in the aorta and carotid). activate sympathetic nervous system or parasympathetic nervous system to alter the rate and force of cardiac contractions What does activation of the sympathetic nervous system (SNS) do? correct answer: tachycardia and contractility What does activation of the parasympathetic nervous system do? correct answer: bradycardia through Vegas nerve
cardiac cycle step 3 correct answer: blood flows into ventricles
- almost emptying atria cardiac cycle step 4 correct answer: conduction system stimulates the atrial muscle to contract, forcing any remaining blood into the ventricles cardiac cycle step 5 correct answer: the atria relax cardiac cycle step 6 correct answer: the two ventricles begin to contract, and pressure increases in the ventricles cardiac cycle step 7 correct answer: the av valves close cardiac cycle step 8 correct answer: all valves are closed, and the ventricular myocardium continues to contract which builds pressure cardiac cycle step 9 correct answer: increase pressure opens the semilunar valves, blood is forced into the pulmonary artery and aorta. right ventricle doesn't need as much pressure because the pulmonary circulation is not as high pressure and systemic circulation. cardiac cycle step 10 correct answer: atria have begun to fill, ventricles relax, the aortic and pulmonary valves close to prevent back flow. what causes cardiac heart sounds correct answer: valves closing
- lubb is AV valves at systole, and dubbings is semilunar valves closing with diastole
why is there a pause after AV node conduction correct answer: allow ventricular filling what impacts stroke volume correct answer: sympathetic stimulation and venous return Cardiac reserve is: correct answer: the ability of the heart to increase cardiac output when needed Preload correct answer: volume of blood in ventricles at end of diastole - ventricles are at their maximum volume Afterload correct answer: The force or resistance against which the heart pumps to eject blood from the ventricles, deterred by peripheral resistance to the opening of semilunar valves - for example impacted by high diastolic pressure :) what does the circumflex artery nourish? correct answer: left atrium and the lateral and posterior walls of the left ventricle systolic pressure is: correct answer: highest pressure, pressure exerted by the blood when ejected from the left ventricle diastolic pressure correct answer: lower pressure, pressure that is sustained when the ventricles are relaxed what impacts blood pressure correct answer: cardiac output (impacted by heart rate, which is sympathetic nervous system and epinephrine) and
Common vasodilators correct answer: nitro, isosoribide (long acting), reduce peripheral resistance systemically, also coronary vasodilators beta blockers correct answer: metoprolol or atenolol , create dysrhythmias and hypertension, block beta adrenergic receptors which prevents SNS from increase heart activity Calcium Channel Blockers correct answer: block movement of calcium ions into the cardiac and smooth muscle fiber, - thus decreasing cardiac contractility, antidysrhythmic in atrial activity, vasodilator. diltiazem, verapamil, nifedipine, amlodipine digoxin correct answer: cardiac glycoside treated atrial dysrhythmias, slows conduction impulses and heart rate, but also increases the contractility so it is more efficient, effective dose is close to toxic dose antihypertensive drugs correct answer: adrenergic or sympathetic blockers (block brain or arteriole SNS alpha adrenergic receptors, or direct vasodilators, calcium blockers, diuretics (remove sodium and water), ACE inhibitors (for CHF, block the renin cascade thing - end in April, reduce peripheral resistance and aldosterone), angiotensin 2 receptor blockers (end in tartan and prevent angiotensin from acting on blood vessels which lowers BP..) anticoagulants correct answer: ASA decreases platelet adhesion, Coumadin blocks coagulation.
cholesterol or lipid lowering drugs correct answer: statins, simvastatin, atorvastatin, reduce LDL and cholesterol content within the blood by blocking synthesis in the liver. lower CRP? what is the leading cause of death in men and women in the US correct answer: coronary artery disease arteriosclerosis correct answer: general term for arterial changes, loss of elasticity of the arteries, walls thicken and harden, and lumen gradually narrows and may obstruct. atherosclerosis correct answer: differentiated by the presence of atheroma: plaque consisting of lipids, cells, fibrin and cell debris often with thrombi LDL correct answer: transports cholesterol from diet and liver to all cells HDLd correct answer: transport cholesterols away from peripheral cells to the liver where it gets stabilized and excreted angina pectoris correct answer: chest pain, which may radiate to the left arm and jaw, that occurs when there is an insufficient supply of blood/oxygen to the heart muscle what is the most common cause of an MI correct answer: coronary artery obstruction due to atherosclerosis with thrombus attached and usually evolve the left ventricle. how long does it take a scar to form on the heart correct answer: 6-8 weeks, beginning on the 7th day.
PAC: extra contractions of the atria (palpitations) atrial flutter: atrial HR over 160-350, ventricular rate is slower atrial fibrillation: over 350 heart blocks: conduction excessively delayed, type one is PR increased, type 2 is increase PR length until one contraction is missed, and total is no conduction in AV node, ventricles slowly contract independent of atrial contraction (significantly reduced cardiac output). ventricular conduction abnormalities correct answer: bundle branch block: does not alter cardiac output but is a wide QRS wave ventricular tachycardia: reduces CO ventricular fibrillation PVCs: v fit can develop from these, mostly they are occasional no big deal what requires a pacemaker correct answer: sinoatrial nodal problems or total heart block Left sided congestive heart failure correct answer: Left ventricle does not empty Blood backs up in pulmonary circulation Pulmonary congestion right sided heart failure correct answer: 1. Jungular Vein Distention
- Ascending Dependent Edema
- Weight Gain
- Hepatomegaly (Liver Enlargement)
what causes congestive heart failure correct answer: infarction, valvular changes, congenital heart defects, coronary artery disease (leading cause) right sided heart failure due to pulmonary disease correct answer: Cor pulmonale why do you have oliguria in both right and left sided congestive heart failure correct answer: because the decreased cardiac output stimulates the renin angiotensin and aldosterone secretions for vasoconstriction and discarding water and sodium VSD correct answer: opening in intraventricular septum, small ones do not affect cardiac function but may increase risk of infective endocarditis. large openings permit a left to right shunt (because left is high pressure). overloads pulmonary circulation causing pulmonary hypertension. pulmonary hypertension can eventually reverse the shunt to right to left which would cause cyanosis valvular defects most often on aortic and pulmonary correct answer: classified as stenosis or incompetent valves Tetrology of Fallot correct answer: pulmonary valve stenosis, VSD, destroposition of the aorta , rightt ventricular hypertrophy rheumatic fever (rheumatic heart disease) correct answer: an inflammatory disease that occurs mainly in children and affects the heart valves and joints (it can follow after diseases such as strep throat and scarlet fever)
phlebothrombosis correct answer: thrombus in a vein without inflammation initially, clot is less firmly intact and develops silently what is the critical problem of venous thrombosis correct answer: pulmonary embolism cariogenic shock correct answer: results when an inefficient heart cannot sustain adequate circulation common in left ventricular MI vasogenic shock (neurogenic or distributive) correct answer: vasodilation owing to loss of sympatheticc and vasomotor tone (such as in spinal cord injury) or hypoglycemia, or acidosis anaphylactic shock correct answer: system vasodilation and increased permeability septic shock correct answer: Shock caused by severe infection, usually a bacterial infection - endotoxic, causes vasodilation owing to severe infection with gram negative bacteria shock eventually causes acidosis which causes correct answer: vasodilation and relaxed precapillary sphincters what is one of the earliest signs of shock correct answer: cns stimulation 0 anxiety and restlessness, basically hypotension stimulates the SNS causing anxiety and restlessness
definition of a stressor correct answer: any factor that creates a significant change the body or environment. physical, psychological, or a combo. definition of stress correct answer: occurs when an individual's status is altered by his or her reaction to a stressors three stages in stress response the GAS (general adaptation syndrome) - Seyle. correct answer: alarm stage: body defenses mobilize in the hypothalamus, SNS, and adrenal glands resistance stage: hormonal levels are elevated and essential body systems operate at peak performance stage of exhaustion: body is unable to respond further or is damaged by the increased demands what is the first hormonal increase in response to stress correct answer: immediate increase in adrenocorticotropic (ACTH) hormone secretion then followed by cortisol. process of stress response in the body correct answer: stressor activates the CNS and thus the hypothalamus. The hypothalamus activates the SNS (norepinephrine) and adrenal medulla (norepinephrine and epi) as well as the central nervous system through the pituitary to release ACTH and subsequently the adrenal cortex releases cortisol and aldosterone. the posterior pituitary releases ADH physiologic effects of chronic stress correct answer: renal failure, perforating stomach ulcers (intense vasoconstriction in the gastric mucosa decreases mucosal regeneration and mucus production, decrease motility, and cortisol delays tissue
what is the incidence of lung cancer correct answer: third most common cancer in the US, more in men, esp black men. what is sleep apnea correct answer: thin pharyngeal tissues collapse during sleep leading to repeated and momentary cessation of breathing complications of sleep apnea correct answer: type 2 diabetes pulmonary hypertension right sided CHF, CVA, erectile dysfunction, depression, daytime sleepiness What is extrinsic asthma? correct answer: Asthma that is caused by substances outside the body, such as pollen, dust, food additives. - called a type one hypersensitivity to inhaled antigen what is intrinsic asthma correct answer: Nonimmune Causes - virus, air pollutants, aspirin or nonsteroidal drug sensitivity, stress, exercise, cigarette smoke how do the bronchi and bronchioles respond to in asthma correct answer: inflammation of mucosa with edema contraction of smooth muscle (bronchoconstriction increased secretion of thick mucus what is COPD characterized by correct answer: progressive tissue degeneration and obstruction in the airways of the lungs what are three examples of COPD correct answer: emphysema, chronic bronchitis, chronic asthma
what is restrictive lung disease correct answer: occupational lung disease, asbestosis, farmers lung - cause interstitial inflammation and fibrosis resulting in loss of compliance or stiff lung what is for pulmonale correct answer: right sided heart failure due to lung disease what is the significant change in emphysema correct answer: destruction of alveolar walls and septa which leads to large permanently inflated alveolar air spaces why is expiration difficult in emphysema correct answer: loss of elastic fibers causes inability of the lung to recoil on expiration and interference with passive expiratory airflow (often r/t to the narrowed airways and weekend walls) Why does barrel chest occur? correct answer: more fixed position of the ribs in the inspiratory position (due to hyperinflation) and from loss of lung elasticity). what position is the diaphragm in on X-ray of a person with emphysema correct answer: flattened why does c0r pulmonale happen in emphysema correct answer: pulmonary blood vessels are destroyed and hypoxia causes pulmonary vascoconstriction, this results in increased pressure in the pulmonary circulation and increased resistance to the right ventricle
what is pneumoconiosis correct answer: chronic restrictive diseases resulting from long-term inhalation of irritating particles (asbestos) -fibrosis develops with destruction of connective tissue, irreversible what is pulmonary edema correct answer: fluid collecting in the alveoli and interstitial area, reduces oxygen diffusion into blood what can cause pulmonary edema correct answer: - inflammation in the lungs which increases capillary permeability -plasma protein levels are low, decreasing plasma osmotic pressure -pulmonary hypertension (left sided heart failure what is a pulmonary embolus correct answer: A blockage of the main artery of the lung or one of its branches by a substance that has travelled from elsewhere in the body (most often from leg veins) through the bloodstream. S/S include SOB, CP on inspiration, palpitations, Cyanosis above the nipple line, low O sats. What is atelactasis & who is at high risk for it? correct answer: non aeration or collapse of a lung or part of a lung leading to decreased gas exchange and hypoxia - can be caused by surgery, external pressure, or blockage what is a pleural effusion correct answer: excessive fluid in the pleural cavity
what is some differences between atelactesis and pleural effusion correct answer: in atalactesis - often the shift will happen toward the affected side as the unaffected side attempts to compensate, in pleural effusion the shift is toward the unaffected side as the affected side gets bigger due to fluid build up. what is a pneumothorax correct answer: air in the pleural space
- this prevents expansion of the lung When is surfactant produced? correct answer: 28-36 weeks, promotes alveoli expansion and reduces surface tension what is the pathophysiology of acute respiratory distress syndrom correct answer: injury to the lung results in injury to alveolar wall and capillary membrane leading to release of chemical mediators, increased permeability of alveolar capillary membranes, increased fluid and protein in the interstitial area and alveoli, and damage to the surfactant-producing cells - can be caused fro severe of prolonged hypoxia which damages lung tissue acute respiratory failure correct answer: pa02 less than 50 and / or paC02 > 50 and decreasing ph <7. at what rate does muscular loss occur in immobility correct answer: 12% each week. at 3-5 weeks half of mass is lost how long does it take tendons and ligaments to be effected by immobility correct answer: 4-6 days, the connective tissue
